Peds Lab Final Prep Flashcards

(178 cards)

1
Q

What is the minimum weight for an LTV 1200 Vent?

A

5 kg (11 lbs)

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2
Q

T or F: In the LTV 1200Control Mode; breaths can be triggered either by patient or machine

A

False; In the control mode (sensitivity set to dash) & display says a/c; only machine breaths are allowed; no patient triggered breaths are allowed

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3
Q

In LTV 1200 what settings differentiates A/C mode from control mode?

A

Sensitivity; when on will be A/C; when off is control mode only

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4
Q

In LTV 1200 breaths that are pressure or volume are given according to either Vt or PC and what other variable?

A

Insp Time

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5
Q

T or F: Bias flow can be turned off on the LTV 1200

A

True: when O2 conserve is turned on than bias flow is turned off & it reduces assistance with patient triggering

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6
Q

During which phase of breathing (inhalation/exhalation/both) is bias flow constant at 10 lpm to assist with pt triggering?

A

Exhalation

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7
Q

What causes flow to be set to 0 l pm in the ltv 1200?

A

insp hold maneuver

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8
Q

T or F: The LTV 1200 is peep compensated

A

True

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9
Q

In the LTV 1200 when leak compensation is set it compensates for leaks in:
A. ETT
B. Patient Circuit
C. Both A & B

A

B. It compensates for leaks in pt circuit; if leak unstable during exhalation will not be detected; it will improve pt triggering by gradually adjusting pt sensitivity

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10
Q

Which is best to use for ideal trigger sensitivity in LTV 1200?
A. O2 conserve On
B. O2 conserve Off

A

A. O2 conserve off provides best trigger sensitivity

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11
Q

What is a reason you would want O2 conserve to be on in the LTV 1200?

A

When you are concerned about running out of a source of O2, such as on portable O2 canisters during transport

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12
Q

Name the 3 surfactant types available?

A

Curosurf; Survanta, InfraSurf

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13
Q

Newborn who weighs 8lbs has been intubated & xray done shows ETT tube in good position, bilateral ground glass appearance with air bronchograms. What disease process would you suspect?

A

RDS

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14
Q

What therapy might be prescribed for an infant suspected of RDS?

A

Surfactant

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15
Q

If you are dispensing Infasurf for a baby that weighs 8lbs how much surfactant would you use & how many doses & how often? How should it be drawn up

A
Q6 x 4 doses with a total of 10.8 mL
8 lbs/2.2=3.63 kg
dose is 3 ml/kg x 3.63 ; 
3.63 x 3 =10.9
Draw up slightly more than needed & fill up ETT catheter; 0.5 more
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16
Q

You are ventilating a baby on a Babylog 8000 & the physician feels the bias flow is too high & you need to maintain the flow at 2lpm; what option would you use

A

VIVE: volume in; volume out

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17
Q

When oxygenating a term infant you must be careful in weaning the Oxygen level, why is this so important?

A

To prevent instability & possible desaturations

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18
Q

You are ventilating a baby who is 26 wks & weighs 820 g; the infant is intubated and given first dose of surfactant; they are currently on a t-piece resuscitator at 20/5, rate 35, FIO2 of .45; Insp time of 0.30 sec; What is the I:E ratio?

A

1:4.8

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19
Q

In a 8 lbs newborn you are using babylog 8000; you must achieve a Vt of 5 cc/kg; how would you achieve this goal and would is your desired Vt for this baby?

A

Use Volume guarantee

Vt = 18 [8lbs/2.2=3.6 x 5 = 18]

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20
Q

What is the narrowest part of the pediatric airway? What is the narrowest part of the adult airway?

A

cricoid for pediatric is narrowest & Larynx (or vocal cords) is the most narrow in adults

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21
Q

In a pediatric patient how can you determine the depth you should place your ET tube?

A

ID x 3

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22
Q

When intubating a pediatric patient; you would most likely use a miller or straight blade & lift _____ with tip and it is placed and pressed against the tip of the tongue.

A

epiglottis

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23
Q

What is the purpose of a cuffed ETT?

A

To create a seal to occlude air leaks

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24
Q

A 820 g infant is a ______ kg; or _____ lbs

A

.82 kg or 1.8 Lbs baby

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25
When administering surfactant how long do you wait before suctioning per the SLP?
2 hours minimum
26
A 4 yr old child in ED who is 36 lbs is intubated following severe asthma attack; Do you use pressure or volume ventilation? Why?
In pressure more comfort & prevents barotrauma
27
What is the name of Volume assist control mode in Servo-i
Volume Control
28
T or F: You cannot do a plateau with an uncuffed ET tube
True
29
T or F: You can obtain a plateau during a nebulizer treatment
False
30
If you have a congested infant, what might you use to help relieve?
Oxyhood
31
After extubating a term infant you are told to place them on 4 lpm HFNC; What equipment would you need?
Blender/cannula | Bag/mask in case needed for resuscitation
32
In the first 12 hrs may see cyanosis, tachypnea, refractory hypoxemia, respiratory distress such as grunting, retractions, nasal flaring, PVR is high & may be caused by MAS, RDS or asphyxia or unknown cause?
PPHN
33
``` A change in respiratory rate may indicate a change in the level of? A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
B. Ventilation
34
``` A change in the SpO2 level indicates a change in level of? A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
A. Oxygenation
35
``` Discoloration of mucus membranes may indicate a problem with A Oxygenation B. Ventilation C. Circulation D. Perfusion ```
A. Oxygenation
36
``` Changes in Urine Output may indicate a change in: A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
Circulation & Perfusion | C & D
37
``` A change in HR may indicate a problem with: A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
A: means oxygenation | A change in strength of HR may mean circulation problem
38
``` If you observe a patient who is having labored breathing this is a function of problems with: A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
B. Ventilation
39
A person who loses their sonsorium is probably having problems with: A. Oxygenation B, Ventilation
A. Oxygenation
40
``` If you are concerned about a person's BP what type of problem might they be having? A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
D. Perfusion
41
``` If you have a hemodynamically unstable person, most likely ______ is a problem. A. Oxygenation B. Ventilation C. Circulation D. Perfusion ```
D. Perfusion
42
Ventilation is achieved at _____ level; Perfusion is achieved at ______ level.
Ventilation is achieved at alveoli level; & perfusion is achieved at the capillary level
43
_______ is achieved when RBC transfer O2 to tissues at the capillary level.
Perfusion
44
________ is a gol of breathing.
Ventilation
45
Respiration requires _______ & _______.
Ventilation & perfusion
46
``` ______ is a major indicator of hemodyamic status as it relates to perfusion. A. HR B. Strength of pulse C. BP D. RR ```
C. BP is a major indicator of perfusion adquacy
47
T or F: You cannot use free-flow O2 with a self inflating bag
True; never use free flow O2 with self inflating bag
48
In order to achieve a PIP of 40 cmH20; what should you do if using a self inflating bag?
Occlude the pop off or pressure relief valve when higher PIP are needed
49
T or F: If you notice the self inflating bag is easy to squeeze and you see no chest rise; or no flow at patient outlet this means your pop off valve is probably occluded
False; These most likely mean your pop off valve is open, you have a malfunctioning inlet valve or rebreathing valve malfunction
50
T or F: It is possible to achieve 100% O2 delivery with a Self inflating bag
True; this can be achieved when you attach an oxygen reservoir
51
What are the 4 mandatory parts of the self inflating bags?
Air inlet Oxygen inlet Patient outlet Valve assembly
52
Which valve is closed at exhale on the self inflating bag to prevent rebreathing?
Valve assembly between the lung & patient outlet
53
Name 4 indicators of oxygenation?
HR, Sensorium, Color, mucus membranes, SpO2
54
Name 4 indicators of ventilation?
Chest rise, breath sounds, labored breathing, respiratory rate
55
T or F: If a leak is present on flow inflating bag then bag will not inflate properly
True
56
What level should you set your flow to O2 on a flow inflating bag?
6-12 lpm
57
T or F: A flow inflating bag should be completely full between breaths either by adjusting flowmeter or flow control valve
False: flow inflating bag should be 1/2 full between breaths
58
When assessing APGAR score in babies what 5 items should be part of the initial assessment?
HR, RR, Color, Tone, & Reflex irritability
59
Which vital sign normally is the last you will assess as changes often happen later to it as body compensates?
BP
60
T or F: Acro-cyanosis is not common during a 5 min assessment following birth
False: Acro-cyanosis is commonly seen in newborns 5 min following birth
61
T or F; A HR Between 60-100 would generate a perfect APGAR score of 2
False; it would be scored at 1; a rate above 100 is a perfect apgar score
62
T or F: When assessing muscle tone if you straighten a babies arm and they then pull back this would be considered "good tone"
True
63
T or F: A reaction to a stimulus is considered good when assessing reflex
True
64
At what time intervals are APGAR assessments done following birth?
1 minute; 5 minutes; until score of 7 reached
65
A manometer indicates the _____ pressure of self or flow inflating bags. A. Mean B. Plateau C. Peak pressure
C. Peak pressure
66
Name the 3 shunts prior to birth:
Ductus arteriosus; ligamentum arteriosus; foramen ovale
67
Where should an ETT be placed at intubation when viewing an xray?
Below clavicle & above carina
68
What is used to decompress the stomach at intubation? Where is it usually located?
OG tube located right below the xyphoid
69
What is the max weight on a babylog 8000?
10 kg
70
T or F: It is not necessary to remove a flow sensor when administering a nebulized treatment via babylog 8000
False; you should remove the sensor to prevent wearing & contamination of flow sensor
71
In babylog 8000 when pressing the + menu key makes the ventilator more or less sensitive?
Less | When vent less sensitive it is harder to trigger
72
In babylog 8000 what option under "vent options" may make your WOB easier?
VIVE (Flow In/Flow out)
73
In babylog 8000 what must be "off" in order to have a continuous bias flow?
VIVE
74
T or F: Babylog 8000 has no BIPAP mode
True; no bipap mode exists but PSV can be used like bipap
75
T or F: Babylog 8000 has a NIV mode
False; no non invasive mode exists on babylog 8000
76
T or F: You can ventilate with HFV on a babylog 8000 who weighs less than 2 kg
True; HFV is available on babylog 8000 foor neonate < 2 kg
77
In a babylog 8000 you must also address this setting in order to change your mode from CMV to SIMV?
Trigger setting; if you change from CMV to SIMV & do not change trigger to =/- this will cause your mode to default to IMV instead of SIMV
78
If a patient becomes apneic in PSV mode in Babylog 8000 how is the mechanical rate determined?
Tin | Tex
79
In babylog 8000 inspiratory flow is applied during ________ (mandatory/spontaneous/ both types) breaths. Expiratory flow is applied to (mandatory/spontaneous/both) types of breaths.
Inspiratory flow during mandatory breaths | Expiratory flow applied during spontaneous or CPAP breaths.
80
In babylog 8000 how would you clean your flow sensor or exhalation block?
Autoclave
81
In a babylog 8000, which mode allows for spontaneous breathing? CMV or AC
CMV
82
When adding a nebulizer to any neb from external source such as flowmeter what must you do to your settings with an infant?
You must adjust your PIP downwards; You want to ensure your patient is receiving the same pressures with the addition of the nebulizer
83
With a volume guarantee (VG) mode what is used to ensure a Vt is given
Pressures are adjusted up to your PIP set; whatever amount is needed to deliver the requested volume
84
The LPM of O2 delivered to a baby in a nasal cannula is not the same as that for adults; it delivers _______ (higher/lower) FIO2;
higher they have a higher FIO2 %; whereas the MV and PIP are less; you set a low flow device by RR, pattern, & depth so 1 LPM will not equal 24% FIO2
85
T or F: In a Servo-i since it is peep compensated; if you adjust your peep the vent will automatically adjust your pressure control to achieve same levels; you do not need to touch your pressure control level
False; Adjusting peep means you need to adj your pressure control to keep same level
86
In the servo-i, the nebulizer is ______ powered. A. Pneumatically B. Electrically C. None of the above, no nebulizer treatments available on this vent
B. electrically powered | Can use aerogen neb
87
``` If a nebulizer is pneumatic then it is powered by ______. A. Pressure B. Flow C. Electric D. Vent Mode ```
B. Flow; pneumatically powered nebs are powered by flow; | Servo-I uses electric or outlet power
88
In servo-i; a ventilator is least sensitive at A. 1 B. 10
A. 1 | The closer to 0 the harder to trigger (least amount of sensitivity)
89
In servo-i if you see a red line at bottom of screen when adjusting your trigger this means? A. Vent will be hard to trigger B. Vent is at risk of auto-triggering C. Vent is probably too sensitive for pt to trigger
B. vent may auto trigger with this setting
90
T or F: The servo-i is a pressure oriented ventilator only
False; Servo-i can use pressure oriented or volume oriented modes
91
In servo i-raching your breath is based on a constant flow from your _____ & _____.
Vt & Ti
92
In servo-i which type of breath would you expect to see the most flow at the beggining of the breath with a gradual decrease of flow once plateau pressure met? A. Volume oriented breath B. Pressure oriented breath
B. Pressure oriented breath Flow is needed to reach plateau then greadually decreases flow vs volume breath which has constant flow which is gradually increaased to meet setting level
93
In air leaks with servo-i what happens to Peak pressure in PRVC? A. Increases B. Decreases
A. decreases | this vent focuses on inspiratory side in PRVC so it will cause smaller peak pressures
94
PRVC focuses on ______ (insp/exp) side while VG focuses on _______ (insp/exp) side. If you have a leak in VG then your PIP will ___________ (increase/decrease) in contrast a leak with PRVC will cause an (increase/decrease)_______ in PIP.
PRVC focuses on inspiratory which means leak will decrease PIP; VG focuses on expiratory side which will cause increase in PIP with leak
95
In servo-i which mode should you select to achieve spontaneous breathing with only back up rate & pressure support to achieve a volume guaranteed?
Volume Support Mode
96
Which mode in Servo-i is most like APRV?
Bi-Vent
97
In servo-i if you are using the Bi-vent mode the pressure support you set must be ________ than your P high. A. Less than B. less than or equal to C. Higher than D. Does not matter; depends on goals of WOB
C. Higher than | Your P-high just like in APRV must be set above your pressure support in order to ensure you do not lose recruitment
98
The servo-i has a special mode of ventilation which measures _______ instead of pressure or flow triggering of breath.
Diaphragm
99
In servo-i a gradual rise in pressure affects what measure?
Mean airway pressure
100
In servo-i there is a setting for compressible volume lost; this means the vent will compensate for volume lost in the ______. A. ETT B. Circuit C. Both ETT & Circuit
B. Circuit
101
In servo-i what must you do to ensure PIP is not exceeded? A. Enter the PIP level directly through settings menu B. Enter the PIP level through the PIP alarm C. Ensure your pressure pop up is enabled D. Monitor your plateau pressures through insp hold maneuver
B. PIP level is maintained via alarm setting in servo-i
102
Any gas delivered to infant should utilize ______ (which device?)
blender
103
In babylog 8000 what settings must you change to set your RR?
I time knob= increased insp time = decreased rr (inversely related); changing this will also affect your I:E ratio
104
Some disadvantages associated with the oxyhood is?
Noise levels especially with air entrainment nebs/ also you must ensure sufficient flows to washout any CO2 (4-6 lpm)
105
A special nebulizer used to deliver ribavarin for RSV patients is called ______.
A spag is used to deliver ribavarin; it is a large unit with internal parts; usually used with oxyhood or croup tent; will have 18 hrs on & 6 hrs off
106
The oxygen challenge can be used to differentiate a condition in a baby; if you put a baby in 100% O2 for 15 min via oxyhood if you have a pulmonary issue you will see improvement in stats; if no improvement what is the most likely issue?
Cardiac | Improvement = pulmonary vs cardiac
107
How can you determine the max volume you can deliver? what formula to use
Max volume= Insp flow x I-time
108
When administering surfactant, what should you change your insp time too?
I-time at surfactant administration is: 0.5 immediately before then reduced immediately after dose given
109
What RR & Vent mode should be used during surfactant administration?
IMV at 40-60
110
What FIO2 should you use when adminstering surfactant?
100%
111
T or F: Surfactant must be warmed prior to administration using a natural method
True
112
Why do you add more surfactant dose to syringe than is needed?
The feeding tube must be primed with surfactant so that the required dose may be left to administer in syringe
113
What values should you wean once surfactant administered?
PIP, FIO2, I time
114
What is the correct dosing for curosurf?
2.5 ml/kg for 1st dose then subsequent is 1.25 ml/kg; q12; 2 positionings/ left sided with right side dependency
115
What is correct dosing for survanta?
4 ml/kg 1 dose/ then subsequent doses at 4 ml/kg; q6 x 4; 4 positionings left sided/with right side dependency
116
What is correct dosing for infra surf?
3 ml/kg 1st dose during ventilation breaths of 20-30 for each aliquot/ subsequent at 3ml/kg; q6 x 4; 2 positions right sided/with left sided dependency
117
What anatomical difference makes an infant intubation harder than an adult?
Larger tongues; making obstruction more prevalent; also tonsils and adenoids more prominent exposing them to more obstruction during illness when swelling occurs
118
What compensation method is used in breathing for infants?
An increase or decrease in RR as they cannot regulate their depth of breathing
119
True apnea in infants needs to last longer then _________ seconds.
15-20 seconds
120
What condition may result from over-ventilation of infant with positive pressure?
BPD (like emphysema)
121
What FIO2 should you use when delivering compressions?
100%
122
If you have a neonate who weighs 1.5 kg what ETT size would be best? Where should the tube be placed? What size suction catheter should be used?
3.0 mm ETT; 7 at gums for securing ETT | Suction catheter: 5
123
How can you estimate a mean BP for an infant as to what it should be?
Gestational week + 5
124
In high frequency 1 hz = ____ bpm
60 bpm
125
In HFV what has more impact Vt or RR?
Vt has more impact
126
In HFJV what can help prevent air trapping?
Use of peep with regular conventional ventilator
127
What are the 3 control settings on HFJV?
PIP: Start 20-30 (range of 8-50) I time: .02 - .034 sec Rate: 420 default (range of 240-660 bpm)
128
In HFJV the amount of force needed to meet a target is ________.
Servo Pressure
129
In HFJV when your compliance improves what happens to servo pressure?
Servo Pressure increases
130
When lung volumes decrease (or compliance decreases) what happens to servo pressure?
Servo Pressure will decrease (smaller volumes mean less pressure needed to meet target Vt)
131
The main determinant of PaCO2 in HFJV is which setting? A. PIP B. I time C. Rate
A. PIP It is inverse; if you increase your PIP then decrease your PaCO2; but decrease in PIP will also decrease your MAP (may decrease your oxygenation)
132
How do you determine your delta P in HFJV?
PIP - Peep | The greater the Delta P the more you decrease your PaCO2
133
In HFOV, ventilation or delivered volumes is directly proprotional to _______.
Amplitude or Delta P
134
In HFOV, ___________ facilitates both oxygenation & ventilation
Continual distending pressure (Paw)
135
``` In HFV the main adjustment to make to improve ventilation would be changes in your ________. A. Amplitude B. Mean airway press C. Frequency D. CDP ```
A Amplitude.
136
``` In HFJV, the main determinant of PaCO2 levels is ____. A. Frequency B. I time C Pip D. None of the above ```
C. PIP; inversely related; decreased PIP = increased PaCO2 | Large or greater delta P change will decrease PaCO2
137
On HFOV, initial settins for patient: | Ti, Rate, Flow, Rate: Amplitude, MAP
Ti = 33%; Rate: neonates 12 (larger pt=jogjer frequency); Flow approx 10 on neonates
138
In HFOV, when you decrease your rate, your PaCO2 will ______. (increase/decrease)
Decrease/ because Vt will decrease
139
In HFOV, you can increase your MAP by increasing ____.
Flow
140
In HFOV, alarms are set & once level reaches the preset limit what happens?
The HFOV cuts off and goes to CPAP
141
A recruitment maneuver used on HFOV is called?
40/40; 40 cpap for 40 seconds; or map of 40 for 40 seconds; if they cannot handle the sustained pressure on CV they will not be able to handle on the HFV
142
One one condition that is not good with HFOV is ______ fluid levels.
Decreased fluid levels
143
Pressures that are received at the alveolus level are very _____ in HFV.
Small; even though uses a high frequency it does not reach alveolus levels
144
On Crossvent 3, what is a O2 saving mode?
Using the air entrainment on side of vent; less than 50% will reduce use of O2 by 2/3
145
If you need to conserve O2 on the LTV what can you do?
Turn on O2 conservation which wilodeClarke electrl turn off your bias flow
146
HFJV vs HFOV; one is servo pressure & one is power; which one matches
HFJV = servo pressure; HFOV = power
147
What type of electrode is used with transcutaneous monitor?
Clarke ELectrode
148
What are 2 types of ETCO2 monitors?
Sidestream: Takes at ETT & analyzes in machine Mainstream: Real time analysis; more accurate with low Vt so may be better with babies but heavier
149
T or F: In HFV, CO2 measurements may be meaningless.
True
150
``` In TCM, what location may be better for monitoring? A. Chest or abdomen B. Heal of foot C. Rt arm D. Left Arm ```
A. Chest or abdomen since it requires good circulation to skin
151
When obtaining an ABG, the best place to stick when an umbilical or art line is not available is _____.
Heal; but the pH may be slightly lower at 7.32 - 7.35
152
Measuring capillary blood gas may cause ______ readings. (higher/lower but only slightly).
Lower
153
In HFOV, when you increase _______ you increase ammplitude.
Power
154
How can you compensate when MAP decrases when you remove air from cuff to remove PaCO2?
Increasing flow rate
155
``` In HFOV, the last item to address when removing PaCO2 is _______. A. Deflating Cuff B. Increasing amplitude C. Decreasing frequency D. Increased Ti ```
D. Increased Ti from .33 - .50
156
An immune response that may look like pneumonia on an xray & can be caused by any insult to the body which generates an immune response
SIRS
157
``` In the Crossvent 3 when your max pressure is inadequate what happens? A. A leak is created B. Volumes are lost C. None of the above D. Both A & B ```
D. both A & b
158
What setting on Crossvent 3 controls PIP?
Max Pressure
159
T or F: In hypoplastic Rt Heart you have only one pump which is the left heart & a 3 step surgery is used to correct making patient very sensitive to Peep and PPV as it reduces venous return, reducing intervascular volume
True
160
Apnea of Prematurity can be treated with _____ therapy.
CPAP
161
A problem of treating Croup with Racemic Epinephrine is risk of ______.
Rebound effect; symptoms seem to improve but returns as soon as symptoms stop as disease worsens; only masking symptoms
162
A minimal level of saturation in preemies is _____.
85%
163
In every newborn, the pulse ox should be placed on _____ side.
Right side
164
When assessing need for intervention with MAS what drives the decision?
The response of baby, if vigorous or not; do not ventilate via same tube used to suction
165
If a baby has MAS this may incrase their potential for having _____.
PPHN
166
The diagnostic too dx PPHN is the _______.
Echocardiogram, it gives pulmonary artery pressures (PAP) in all chambers & pulmonary artery of heart
167
In PPHN, it is best to use Ti that are _______. (shorter/longer)
Ti should be shorter; as greater ones can harm lungs; RR around 40, CO2 in 50's ok
168
In a newborn infant suspected of hypoxic brain injury _____ can be a treatment. (Cooling/Warming)
Cooling; it may be ok to turn off radiant warmer
169
______ may be an important measure of perfusion, if you see it decrease can cause your BP to bottom out;
SVO2; can correct by giving fluid
170
``` When treating asthma, what combination of Ti/Te is best. A. Longer Te/Shorter Ti B. Longer Ti/Shorter Te C. High RR D. Smaller RR ```
A & D | Smaller RR; Shorter Ti & longer Te
171
``` One non traditional form of therapy that can be used with BPD is: A. iNO B. APRV C. Heliox D. N & O2 ```
C. Heliox
172
In bubble CPAP; bubbling means:
Inspiratory flow has been met or exceeded
173
When your hear ________, you know you have a good seal & patent airway.
Bubbling in chest
174
When troubleshooting BubbleCPAP, if have bubbling which starts & then diminishes what could be the problem?
You may need more flow
175
In bubble CPAP, if bubbling suddenly stops then what may have happened?
You may have lost your seal
176
A disadvantage of CPAP or Sipap stand alone units is that:
It is hard to monitor; can be issue with weak patietns or tachypnic
177
Sipap is avail with what interfaces?
Nasal Mask/or nasal prongs
178
In Sipap, when using an abdominal monitor at 8lpm to flowmeter means ____ cpap.
5 of cpap